Background: Evidence links gamma-glutamyl transferase (GGT) to mortality in the general population. However, the relationship of GGT with all-cause and cause-specific mortality risk has been little explored in type 2 diabetes mellitus (T2DM) patients.
Methods: We recruited 20 340 community-dwelling T2DM patients between 2013 and 2014 in Jiangsu, China. Cox regression models were used to assess associations of GGT with all-cause and specific-cause mortality. Restricted cubic splines were used to analyze dose-response relationships between GGT and mortality. Stratified analysis was conducted to examine potential interaction effects by age, sex, smoking status, body mass index (BMI), diabetes duration, and dyslipidemia.
Results: During a median follow-up period of 7.04 years (interquartile range: 6.98-7.08), 2728 deaths occurred, including 902 (33.09%) due to cardiovascular disease (CVD), and 754 (27.58%) due to cancer. GGT concentrations were positively associated with all-cause, CVD, and cancer mortality. Multivariable hazard ratios (HRs) for the highest (Q5) vs. the lowest quintile (Q1) were 1.63 (95% confidence intervals [CI]: 1.44-1.84) for all-cause mortality, 1.87 (95% CI: 1.49-2.35) for CVD mortality, and 1.43 (95% CI: 1.13-1.81) for cancer mortality. Effect modification by BMI and dyslipidemia was observed for all-cause mortality (both p for interaction <.05), and HRs were stronger in the BMI <25 kg/m2 group and those without dyslipidemia.
Conclusions: Our findings suggest that, in Chinese T2DM patients, elevated serum GGT concentrations were associated with mortality for all-cause, CVD, and cancer, and further research is needed to elucidate the role of obesity, nonalcoholic fatty liver disease, and lipids in this association.
背景:有证据表明在一般人群中γ -谷氨酰转移酶(GGT)与死亡率相关。然而, 在2型糖尿病(T2DM)患者中, GGT与全因死亡率及病因特异性死亡风险的关系研究较少。 方法:本研究于2013至2014年在江苏招募了20,340例社区T2DM患者。采用Cox回归模型评估GGT与全因死亡率及病因特异性死亡率的关系。限制性立方样条用于分析GGT和死亡率之间的剂量反应关系。按年龄、性别、吸烟状况、体质指数(BMI)、糖尿病病程和血脂异常进行分层分析。 结果:在中位7.04年(四分位距:6.98 ~ 7.08)随访期间, 共2728例死亡, 其中902例(33.09%)死于心血管疾病(CVD), 754例(27.58%)死于癌症。GGT浓度与全因死亡率、CVD死亡率和癌症死亡率呈正相关。与最低五分位数(Q1)相比, 最高五分位数(Q5)的多变量风险比为全因死亡1.63 (95% CI: 1.44 ~ 1.84), 心血管疾病死亡1.87 (95% CI: 1.49 ~ 2.35)和癌症死亡1.43 (95% CI: 1.13 ~ 1.81)。观察到BMI和血脂异常对全因死亡率的影响(相互作用P均< 0.05), 并且在BMI < 25 kg/m2 组和没有血脂异常的人群中多变量风险比更高。 结论:在中国2型糖尿病患者中, 血清GGT水平升高与全因死亡、心血管疾病死亡和恶性肿瘤死亡相关, 肥胖、NAFLD和血脂在其中的作用有待进一步研究。.
Keywords: 2型糖尿病; cancer; cardiovascular disease; gamma-glutamyl transferase; mortality; type 2 diabetes mellitus; γ-谷氨酰转移酶; 心血管疾病; 死亡率; 癌症.
© 2023 The Authors. Journal of Diabetes published by Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.